Perianal Fistula-Associated Carcinoma in Crohn's Disease: A Multicentre Retrospective Case Control Study.

Autor: Palmieri C; Department of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Kalk, University of Cologne, Buchforststrasse, Cologne, Germany., Müller G; Department of General and Visceral Surgery, Evangelisches Krankenhaus Kalk, University of Cologne, Buchforststrasse, Cologne, Germany., Kroesen AJ; Department of General and Visceral Surgery, Krankenhaus Porz am Rhein, University of Cologne, Urbacher Weg, Cologne, Germany., Galata C; Department of Surgery, University of Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer, Mannheim, Germany., Rink AD; Department of General, Abdominal and Transplantation Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstraße, Mainz, Klinikum Leverkusen, Germany., Morgenstern J; Department of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Kalk, University of Cologne, Buchforststrasse, Cologne, Germany., Kruis W; Department of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Kalk, University of Cologne, Buchforststrasse, Cologne, Germany.
Jazyk: angličtina
Zdroj: Journal of Crohn's & colitis [J Crohns Colitis] 2021 Oct 07; Vol. 15 (10), pp. 1686-1693.
DOI: 10.1093/ecco-jcc/jjab057
Abstrakt: Background and Aims: Carcinoma associated with perianal fistula in Crohn's disease is a pending threat for patients. This study aimed to improve understanding and facilitate development of diagnostic and therapeutic strategies.
Methods: A retrospective case-control study was conducted at four German hospitals. The analysis included 40 patients with proven malignancy associated with perianal Crohn's fistulas and 40 randomly selected controls with fistulizing perianal Crohn's disease. Differences between groups were analysed and multivariate calculations were performed to describe risk factors for oncological outcomes.
Results: Histology revealed adenocarcinoma in 33/40 patients and squamous cell carcinoma in 7/40 patients. Compared to fistula patients without carcinoma, patients with malignancies associated with fistula had a diagnosis of Crohn's disease at younger age. Crohn's disease lasted longer in patients with malignancy [25.8 ± 9.0 vs 19.6 ± 10.4; p = 0.006]. Fistula-related findings differed significantly between the two groups. Signs of complicated and severe fistulation including complex anatomy and chronic activity occurred significantly more often in patients with malignancy associated with fistula. Significant multivariate hazard ratios for overall mortality and progression-free survival were shown for histological type of cancer, metastatic disease and R1 resection. Overall survival was 45.1 ± 28.6 months and the 5-year survival rate was 65%.
Conclusions: In patients with adenocarcinoma or squamous cell carcinoma associated with perianal fistula in Crohn's disease, fistula characteristics determine the risk of malignancy. Early diagnosis influences outcomes, while treatment of chronic fistula activity may be key to preventing malignancy. Expert multimodal therapy is paramount for successful treatment of perianal fistula-associated malignancies.
(© The Author(s) 2021. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze: MEDLINE
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